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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME Q �`In <br /> DAOID �' e J W 1E S" &1'1R ❑ Zoning Statu • UP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) Deed Res ction;CSM <br /> 3,)_ PPW RDSE a_ArrE 2. RD Varian (# ) <br /> HOME PHONE CELL PHONE <br /> ' E-MAIL ADDREp <br /> ( L �‘o8 sal Lit oo rto ‘13-,2 too ,„;Q �• La,— ve cl7' <br /> %Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> Ct,1.A 12.'x- 7301L7Yi qS ❑ Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/septic <br /> /90 f''(3 / sT . <br /> (City,State,Zip) (City,State,Zip) ❑ Setbacks <br /> VaaDVA 1 WI 3-3Sri3 <br /> PHONE PHONE ❑ Site Plan approval from <br /> goo .373 S.S,S(J applicable township: <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> jg Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http:/laccessdane.co.dane.wi.us/) Elevation of property <br /> PARENT PAR LNUMBER: CURRENT ZONING: ACREAGE: Igi <br /> ❑ PARCEL Olg o5v7-2'3-9S0o-� A-r EX ` Q&�� frontage drawn to scale. <br /> NUMBER J I I -v,! <br /> TOWNSHIP: SECTION: ❑ Driveway 05 (� ,r� i. oSk_ Zg 1/: SW 1/41/4: SE y permits <br /> ADDRESS: (state,county,town) <br /> 3I PRIA\12SE C ,14- 2. ; 1')/It j 3EL1E1/ / Wi 53cog <br /> ❑ Sanitary permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: , <br /> 0 This project is a new building or structure.% R cE A slAjf.,412. 1)440,-tsMED R ' , <br /> ❑This project is an additio alteration to an existing building or structure. g: <br /> SANITARY SERVICE: PERMIT NUMBER: «- '� <br /> ❑SEWER SEPTIC ; m ` --2:-:--- <br /> : ,a <br /> pus _ <br /> HEIGHT IN FEET: I NUMBER OF STORIES: (Not including basement) , a <br /> AREA TO NEAREST SQUARE FOOT: - `� fit. 3•�° r �� <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) 4 <br /> BASEMENT: 1ST FLOOR: ;' .® « �� g <br /> 110 �+/001 4, TOTAL SQUARE FOOTAGE: 4, rt 4 ��« I �1 ,4�F� �, ; <br /> 2ND FLOOR: 3RD FLOOR: _ -A a g - �: <br /> ESTIMATED CONSTRUCTION COST: n �."�� <br /> (Please round to nearest dollar) ♦ • --► '∎ ♦ ♦ 7 � a ««,« <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 1E1 10 ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ®No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? ®Yes ❑No <br /> 4. Has there been a zoning permit issued for thisMMINNVitt00CI Yes ®No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes g No ❑Don't know <br /> 7. Is this to correct a violation? g�`�Z Z 1�� ❑Yes lgi No <br /> a]A1 O3U APPLICATION MUST BE SIGNED <br /> (Continue on Back) —► —► —► <br /> 545-112(4/08) <br />